Barriers and Facilitators to Weight-loss in Patients with Overweight/obesity and Cardiac Disease: a Realist Qualitative Synthesis

Overview

Journal Int J Qual Stud Health Well-being

Specialties Health Services
Public Health

Date 2024 Oct 26

PMID 39460984

Authors

Rachel Bates

Cara Bailey

Anne Topping

Affiliations

Soon will be listed here.

Abstract

Purpose: Lifestyle advice for cardiac patients with overweight/obesity includes weight management, yet few achieve significant weight loss. People with heart disease may require different support to the general population. We synthesized evidence that reported cardiac patients' weight management experiences to identify barriers and facilitators to weight loss.

Methods: Our realist review identified five manuscripts reporting four studies of weight management experiences of people with heart disease. The capability, opportunity, motivation behaviour change model (COM-B) provided the framework for thematic synthesis.

Results: The studies included qualitative data from 117 participants and revealed factors favouring or impeding effective weight management during cardiac rehabilitation (CR) and in participants' daily lives. We identified four major themes illustrating participants' wish to change harmful health behaviours, adopting exercise and psychological strategies to facilitate change, social and professional support, and regaining control after a cardiac event. These themes broadly aligned with the COM-B categories of capability, opportunity, and motivation.

Conclusions: Most cardiac patients with overweight/obesity express a desire to lose weight. Participants preferred personalized services that could adapt to meet their individual needs, but struggled to make sustainable changes for interconnecting psychological, social, cultural, and financial reasons. Consideration of these complexities when designing programmes may help to support successful weight management.

References

Bush T, Lovejoy J, Deprey M, Carpenter K . The effect of tobacco cessation on weight gain, obesity, and diabetes risk. Obesity (Silver Spring). 2016; 24(9):1834-41. PMC: 5004778. DOI: 10.1002/oby.21582. View

Greaves C, Poltawski L, Garside R, Briscoe S . Understanding the challenge of weight loss maintenance: a systematic review and synthesis of qualitative research on weight loss maintenance. Health Psychol Rev. 2017; 11(2):145-163. DOI: 10.1080/17437199.2017.1299583. View

Peters G, Kok G . All models are wrong, but some are useful: a comment on Ogden (2016). Health Psychol Rev. 2016; 10(3):265-8. DOI: 10.1080/17437199.2016.1190658. View

Feng H, Chien W, Cheng W, Chung C, Cheng S, Tzeng W . Risk of anxiety and depressive disorders in patients with myocardial infarction: A nationwide population-based cohort study. Medicine (Baltimore). 2016; 95(34):e4464. PMC: 5400317. DOI: 10.1097/MD.0000000000004464. View

Pathak R, Middeldorp M, Meredith M, Mehta A, Mahajan R, Wong C . Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY). J Am Coll Cardiol. 2015; 65(20):2159-69. DOI: 10.1016/j.jacc.2015.03.002. View

Engel G . The need for a new medical model: a challenge for biomedicine. Science. 1977; 196(4286):129-36. DOI: 10.1126/science.847460. View

Serpytis P, Navickas P, Lukaviciute L, Navickas A, Aranauskas R, Serpytis R . Gender-Based Differences in Anxiety and Depression Following Acute Myocardial Infarction. Arq Bras Cardiol. 2018; 111(5):676-683. PMC: 6248233. DOI: 10.5935/abc.20180161. View

Herber O, Smith K, White M, Jones M . 'Just not for me' - contributing factors to nonattendance/noncompletion at phase III cardiac rehabilitation in acute coronary syndrome patients: a qualitative enquiry. J Clin Nurs. 2017; 26(21-22):3529-3542. DOI: 10.1111/jocn.13722. View

Rycroft-Malone J, McCormack B, Hutchinson A, DeCorby K, Bucknall T, Kent B . Realist synthesis: illustrating the method for implementation research. Implement Sci. 2012; 7:33. PMC: 3514310. DOI: 10.1186/1748-5908-7-33. View

10.

Gale N, Heath G, Cameron E, Rashid S, Redwood S . Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013; 13:117. PMC: 3848812. DOI: 10.1186/1471-2288-13-117. View

11.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

12.

Thorne S . Toward methodological emancipation in applied health research. Qual Health Res. 2010; 21(4):443-53. DOI: 10.1177/1049732310392595. View

13.

Carroll C, Booth A, Lloyd-Jones M . Should we exclude inadequately reported studies from qualitative systematic reviews? An evaluation of sensitivity analyses in two case study reviews. Qual Health Res. 2012; 22(10):1425-34. DOI: 10.1177/1049732312452937. View

14.

Garip G, Yardley L . A synthesis of qualitative research on overweight and obese people's views and experiences of weight management. Clin Obes. 2015; 1(2-3):110-26. DOI: 10.1111/j.1758-8111.2011.00021.x. View

15.

Resurreccion D, Moreno-Peral P, Gomez-Herranz M, Rubio-Valera M, Pastor L, de Almeida J . Factors associated with non-participation in and dropout from cardiac rehabilitation programmes: a systematic review of prospective cohort studies. Eur J Cardiovasc Nurs. 2018; 18(1):38-47. DOI: 10.1177/1474515118783157. View

16.

Minneboo M, Lachman S, Snaterse M, Jorstad H, Ter Riet G, Boekholdt S . Community-Based Lifestyle Intervention in Patients With Coronary Artery Disease: The RESPONSE-2 Trial. J Am Coll Cardiol. 2017; 70(3):318-327. DOI: 10.1016/j.jacc.2017.05.041. View

17.

Lane D, Carroll D, Lip G . Anxiety, depression, and prognosis after myocardial infarction: is there a causal association?. J Am Coll Cardiol. 2003; 42(10):1808-10. DOI: 10.1016/j.jacc.2003.08.018. View

18.

Ogden J . Celebrating variability and a call to limit systematisation: the example of the Behaviour Change Technique Taxonomy and the Behaviour Change Wheel. Health Psychol Rev. 2016; 10(3):245-50. DOI: 10.1080/17437199.2016.1190291. View

19.

Vellone E, Rebora P, Ausili D, Zeffiro V, Pucciarelli G, Caggianelli G . Motivational interviewing to improve self-care in heart failure patients (MOTIVATE-HF): a randomized controlled trial. ESC Heart Fail. 2020; 7(3):1309-1318. PMC: 7261532. DOI: 10.1002/ehf2.12733. View

20.

Powell-Wiley T, Poirier P, Burke L, Despres J, Gordon-Larsen P, Lavie C . Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021; 143(21):e984-e1010. PMC: 8493650. DOI: 10.1161/CIR.0000000000000973. View